Veterinarian Release Form
Owners Name____________________________ Phone_________________________
Pets Name____________________ Breed:______________________ Age_________
Veterinarian:____________________________________________________________
Address of Veterinarian:___________________________________________________
Phone: ________________________________________________________________
Known medical conditions:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
During my absence, Pups@Play will be caring for my pet(s). In the event of an
emergency, I authorize Pups@Play to seek medical treatment and will be
responsible for payment for all out of pocket expenses including but not limited to
veterinarian fees, medication, transportation, upon my return.
I, _________________________________, give Pups@Play permission to transport my
pet(s) to my veterinarian and authorize treatment in the event of an emergency or
sickness.
If this veterinarian is not available, I authorize Pups@Play to transport my pet(s) to a
veterinarian of choice and authorize treatment. If emergency care is needed after
regular office hours, my pet(s) may be taken to the nearest Veterinarian Emergency
Clinic/Hospital.
I give permission to Pups@Play to approve treatment up to $__________________
(input maximum dollar amount or “no limit”). I agree to be responsible for all charges
upon my return including, but not limited to, vet fees, extra visit fees and transportation
fees.
I agree that Pups@Play is released from all liability related to transportation to and from
veterinarian and treatment for sickness or emergency.
This release will remain valid for all current and future visits unless a new release is
signed.
Clients Signature______________________________________________________
Date ____________________________